The Experience and the Characteristics of Patients With Tele-ICU Implementation in a Rural Community Hospital.

Background Tele-ICUs are increasingly being used in the US. In Japan, young physicians mainly operate rural community hospitals to manage severely ill patients. However, the introduction of the tele-ICU system in Japan is still uncommon. We introduced a tele-ICU system to a community hospital. The objective of this study is to determine if the newly introduced tele-ICU system is being effectively utilized. Methods This is a single-center, retrospective observational study. We introduced the tele-ICU system to the NachiKatsuura Town Onsen Hospital, Japan, in 2019. Thereafter, we retrospectively explored the characteristics of the consulted cases, the time of consultation, the Sequential Organ Failure Assessment (SOFA) score, and the number of consultations by month from 1st July 2019 to 31st March 2020. The main outcome was the monthly number of consultations, and other measures included the clinical characteristics of the consulted cases. Results A total of 81 cases were referred to the tele-ICU system within nine months. Sixty-two cases, excluding those with missing data, were included in the analysis. The number of consultations was almost constant during the study period and was most frequent during the day. The recommendations from tele-ICU physicians were mostly "advice on the treatment plan." The mean SOFA score was 2.56. Conclusions We introduced a Japanese-type tele-ICU system for Japanese rural community hospitals. Many cases from rural community hospitals that were referred to the tele-ICU systems were moderately severe and did not require urgent transportation. These cases are not indicated for emergency transportation and should be treated in rural community hospitals.

Clinical Characteristics of Mechanically Ventilated Patients Treated in Non-ICU Settings in a Rural Area of Japan.

Introduction Patients requiring mechanical ventilation (MV) are commonly managed in an intensive care unit (ICU); however, Japan is unique in that many patients are treated in non-ICU settings. The characteristics of these patients, nevertheless, are unknown. We sought to identify disease severity and MV settings of patients in non-ICU. Methods We retrospectively analyzed the clinical data of Kinan Hospital and Owase General Hospital, where there are no ICUs. Data for adult patients who required MV from January through December 2018 were collected. To find the characteristics of patients who have been decided to treat in non-ICU hospitals without early transferring, we analyzed patients who have been treated for more than three days in those hospitals. Results A total of 171 patients received MV; 29 patients were treated for more than three days. Of those, the mortality rate was 44.8% (13 patients). The median age was 80 years (range: 72-84 years). The mean Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score was 20.9 ± 8.1, and predicted mortality was 0.42 ± 0.25. Tidal volume per predicted body weight was 8.8 ± 2.1 mL/kg, and set inspiratory time was 1.6 ± 0.3 seconds. Conclusions We have first described the severity and the initial ventilator setting of MV patients treated for more than three days in non-ICU setting in Japan. The overall predicted mortality was 42%, and the average age of the patients was 80 years. Further research on wider areas and the comparison to the patients treated in ICUs are needed to identify the appropriateness of treating patients in non-ICU settings.